Primary and Secondary Survey

Pre Hospital

Ns. Mohammad Ali Hamid

PROGRAM STUDI S1 KEPERAWATAN
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH JEMBER

Tujuan Pembelajaran
Umum
Setelah mengikuti mata kuliah ini mahasiswa
akan dapat melakukan primary survey dan
secondary survey pre hospital

Khusus
Menjelaskan langkah langkah dalam
primary survey & secondary survey pre
hospital
Menjelaskan prioritas pemeriksaan
Menjelaskan intervensi yang harus dilakukan
dalam primary survey & secondary survey
pre hospital

Scene Survey

Is scene safe?

Protect Self/Team (Universal Precautions).

Protect your patient.

Find Clues for Mechanism of injury/history.

Number of patients.

PRIMARY SURVEY

Adult / Pediatric priorities same

Identified the life-threatening conditions and simultaneously
managed

A: Airway maintenance with cervical spine

protection
B: Breathing and ventilation
C: Circulation with hemorrhage control
D: Disability ( Neurologic status )
E: Exposure / Environmental control: Undress the
patient & prevent hypothermia

Airway

Upper airway obstruction kills.

Talking patients have an open airway.

Common causes of obstruction: tongue,

foreign objects, swelling, direct trauma

Signs & Symptoms: impaired speech,

cyanosis, irregular breathing, stridor,
coughing.

Airway Maneuvers
Head

tilt, chin lift (Caution!)

Jaw

thrust

Left

lateral position

Heimlich
Artificial

airways : oropharyngeal,
nasopharyngeal

Cervical Spine Injury

Include

in airway management.

Suspect

in all blunt trauma

victims, unconscious patients.

Stabilize
Dont

and immobilize neck.

use head-tilt.

Breathing

Breathing is different from airway.

Look
Listen
Feel
Acute Respiratory Insufficiency: abnormal
respiration , use of accessory muscles, nasal
flaring, cyanosis

Breathing

Supplemental Oxygen is a drug!

Spontaneous respiration:
Nasal cannula, face masks,
rebreather and non-rebreather
masks
Non-breathing patients:
Mouth to mask ventilation, BagValve-Mask

Circulation

Assess circulatory function:

Central & peripheral pulse
Pulse rate and character
Skin color, moisture & temp

Circulation

Identify life-threatening hemorrhage:

Rapid , Arterial , Massive amount

Control hemorrhage:
Direct pressure , Splint and elevate,
MAST, Tourniquet

Identify internal hemorrhage.

Disability

Identify level of consciousness

A-alert
V-verbal commands
P-pain
U-unresponsive

Pupil response and size

Expose

Remove clothing as needed .

Maintain body temperature.

Inspect/palpate the entire

body.

Log roll to expose back.

The rapid Assessment

Neck
Inspect/palpate : DCAP BLS, JVD,
Trache deviation, pain
Chest
Inspect/palpate : DCAPP BLS,
Auscultate for breath sounds, Percuss
Abdomen
Inspect/palpate : DCAP BLS, Tenderness

The rapid Assessment

Pelvis
Inspect/palpate DCAP BLS,
TIC
Musculoskeletal
Inspect/palpate DCAP BLS,
TIC, PMS

Load and Go

Kriteria Load and Go

Obstruksi jalan nafas yg tdk dpt diatasi scr mekanik(suction,

forceps atau intubasi)
Henti jantung karena trauma
Keadaan yg menimbulkan pernafasan tdk adekuat (open
pneumothotax, flail chest, tension pneumothorax, trauma
dada yg luas
Shock
Trauma kepala tdk sadar, pupil anisokor/penurunan
kesadaran
Nyeri abdomen
Pelvis tdk stabil
Fraktur femur bilateral

SECONDARY SURVEY

History

A. Allergies
M. Medications currently used
P. Past illness / pregnancy
L. Last meal
E. Events / Environment related to
injury

HISTORY
Mechanisms of injury

Blunt
Automobile collisions
Seat belt usage
Steering wheel deformation
Direction of impact
Ejection of passenger form the vehicle
Burns and Cold injury
Inhalation injury and CO. intoxication in fire field
Hazardous environment
Penetrate
Anatomy factors
Energy transfer factor
Velocity and caliber of bullet
Trajectory
Distance

SECONDARY SURVEY

Physical Examination

Head and Maxillofacial

Inspect and palpate head and face
(DCAP BLS, TIC)
Battles sign
Pupils and LOC
Raccoon eyes
Ears and nose for CSF
Mouth
Skin : pale, cyanosis, diaphoresis

SECONDARY SURVEY

Reassess ABCs
Vital sign
Physical Examination

C-spine and Neck

Inspect for signs of injury, tracheal deviation

- Palpate for tenderness,DCAP - BLS,
subcutaneous emphysema
- Auscultate for carotid bruits

SECONDARY SURVEY

Physical Examination

Chest
Inspect ant, lat and post chest for
injury, use of accessory
- Auscultate for breath sounds
- Palpate for DCAPP BLS, TIC
- Percuss

SECONDARY SURVEY

Physical Examination

Abdomen

Inspect & palpate for signs of injury

or bleeding DCAP - BLS
Auscultate for bowel sounds
Percuss

SECONDARY SURVEY

Physical Examination

Musculoskeletal
Inspect & Palpate extremities for signs
of injury (DCAP BLS, TIC, PMS)
Assess pelvis (DCAP BLS, TIC)

SECONDARY SURVEY

Physical Examination

Neurologic
Determine GCS score
Re-evaluate pupils
Sensory / motor evaluation
Maintain immobilization
Prevent secondary CNS injury
Early neurosurgical consultation

Reassessment Survey
The level of Consciouss
Reassess ABCs
Neck, chest, abdomen, pelvis, ekstremitas
Focused Assesment of Injuries
Check Intervention
( patient is not stable every 5 minute, patient
is stable every 15 minute)

SUMMARY

Initial assessment & management of multiply

injured patient

Primary survey ( ABCDEs )

Resuscitation & monitor ( life-threatening problems

)

Secondary survey ( head-to-toe, history )

Questions?

Referrence
1. Lanros & Barber (1997) Emergency Nursing :
with Certification, Preparation, & Review.USA :
Appleton & Large
2. Springhouse corporation book division (1985).
Nurses Reference Library : Emergencies.
Pennsylvania : Springhouse corporation
3. _____ (1998) Pertolongan Dasar Gawat Darurat
Trauma : Malang.RSUD Dr Saiful Anwar
4. http://www.adhb.govt.nz/trauma/T_guidelines/pr
imary_survey.htm
5. Suhttp://sprojects.mmi.mcgill.ca/trauma/educ/
tutorials/surveys.htmrvey